56例肝硬化患者心功能、NT-proBNP水平与MELD评分的相关性研究

Correlation of cardiac function,NT-proBNP level and MELD score in patients with liver cirrhosis

[目的]评估肝硬化患者心功能、N末端脑钠肽(NT-proBNP)水平与终末期肝病模型评分(MELD评分)的相关性。[方法]入选肝硬化患者56例为试验组,其中MELD≤9分15例,MELD 10～19分18例,MELD≥20分23例;另选同期健康体检者56例为对照组。应用ELISA法测定血NT-proBNP浓度,应用超声心动图检查记录反映心脏收缩(左室射血分数,LVEF)、舒张功能[左房直径(LAs)、舒张早期二尖瓣血流速度峰值(E)、舒张晚期二尖瓣血流速度峰值(A)、计算E/A比值的指标],比较试验组与对照组、试验组中不同MELD评分者间的LVEF、E/A、LAs及NT-proBNP浓度。[结果]试验组与对照组的LVEF、E/A、LAs及NT-proBNP浓度比较均差异有统计学意义(P<0.01),不同MELD评分之间LVEF、E/A、LAs、NT-proBNP浓度两两比较均差异有统计学意义(P<0.01)。Spearman相关检验显示E/A值与MELD评分间呈负相关,相关系数为-0.894(P<0.01);NT-proBNP与MELD评分呈正相关,相关系数为0.913(P<0.01)。[结论]肝硬化患者血NT-proBNP较对照组升高,随MELD评分递增;该地区肝硬化患者存在不同程度心功能损害,其心功能受损程度随肝功恶化加重,患者NTproBNP浓度与肝功能受损水平相关。

[Objective]To evaluate the correlation between cardiac function,NT-proBNP level and endstage liver disease model score in patients with liver cirrhosis.[Methods]NT-proBNP were measured by ELISA Cardiac systolic and diastolic function were measured by echocardiography.The cardiac function and NT-proBNP of different MELD scores were compared and analyzed.[Results]LVEF in the patients with MELD score≤9 and 10-19 were higher than ≥20,and the differences were significant between MELD score≤9 and 10-19,10-19 and≥20(P<0.01);the E/A were descending with the MELD score.And the associations among these three groups were significant(P<0.01).Spearman test showed that there was obviously negative correlation between E/A and MELD score(r=-0.894,P<0.01);the LAs of MELD score≥20 were higher then the other two groups(P<0.01).NT-proBNP levels were elevated with the MELD score.And the associations among these three groups were significant(P<0.01).Spearman test showed that there was obviously positive correlation between the NT-proBNP levels and MELD score(r=0.913,P<0.01).[Conclusion]NT-proBNP in patients with liver cirrhosis in Kashi area is higher than the control group,with MELD scores increased in patients with liver cirrhosis;in the region there are different degrees of impairment of cardiac function,degree of impairment of cardiac function with the deterioration of liver function,NT-proBNP concentration and liver function in patients with impaired level.